Found in 1 comment on Hacker News
danShumway · 2021-10-15 · Original thread
As someone with ADHD, this sets off some (okay, many) red flags for me.

Some thoughts:

- Patient intake for ADHD is genuinely awful, you're right about that. The diagnostic/treatment process for ADHD often feels like it's designed to make people with ADHD struggle.

- CBT is generally helpful, therapy is an important part of treatment. I've seen good results from it.

- in-person sessions are expensive (although if you have good insurance you shouldn't be hitting $200-300 a session).

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However:

- Non-personalized CBT may not be as helpful. One thing I've learned working with my therapist is that a lot of behaviors I thought were universal aren't, even among people with ADHD. We spend a lot of time breaking down what my motivators are, what things I struggle with, and we spend a lot of time brainstorming coping mechanisms and exercises that will work specifically for me. There is no single technique to deal with all of this, and you really need to have some way of narrowing in on what type of ADHD you have and what other conditions (anxiety, autism, etc) might complicate it.

- "5 minutes a day" is not really CBT to me. CBT is work, and I'm immediately skeptical of any app that tells me I'm just going to do some quick daily exercises and it'll change my life. Therapy doesn't work that way in my experience.

- I'll also note that the reason that the average cost of a CBT session is so high is because it's a personalized, one-on-one session that can last as long as an hour. So I feel even more that the comparisons being made here to traditional therapy aren't very apt.

- A self-directed routine that isn't being done with a real person kind of misses the point that people with ADHD often have trouble forming and sticking to routines. "You just need to do X every day and be mindful" isn't good advice for someone with ADHD, the whole point of CBT is to teach you how to do that stuff. But in this case, being able to stick to a consistent routine feels like a pre-condition to using the app.

- The app can't be used for diagnosis, and I really feel like diagnosis is important. Diagnosis, insurance coverage, and medication access are the reasons why the ADHD intake process is so complicated. Of course it could be better, but I don't feel like you can brag about circumventing the intake process if the way you're circumventing it is by skipping all of the hard parts that are of significant long-term value to people with ADHD.

- Medication is often used in combination with CBT, and I feel like it's irresponsible not to get into that or even mention it. The pitch makes it seem like CBT on its own is going to solve every problem, but for many people it won't. Therapy didn't work for me at all until I got on medication, and then suddenly I had the ability to start to utilize a lot of the techniques I was learning and to be more mindful throughout the day.

- Other people have brought up the pricing model, but I just want to reinforce that this feels predatory to me, it feels designed to capitalize on behaviors that people with ADHD struggle with.

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Getting more critical. From the FAQ:

> We are not trying to replace medication or in-person therapy.

This is not how you're phrasing your post on HN. If you're building a quick helper app so that people can do daily CBT exercises, then say that. I wouldn't be so critical of an app like that, I can see a lot of use for a Duolingo-style CBT exercise/reinforcement app.

But when you compare the price of your app to traditional therapy and intake, you are creating an implication that your app is a substitute for therapy or medication. And it's not, you need to be more upfront about that and you need to stop comparing your product and your product's pricing to normal medical treatment.

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With all of the above in mind, (to me) $100 a year feels too expensive for a 5 minute helper app that many people with ADHD won't have the ability to keep up with or stick to unless they're already getting therapy and/or medication.

If you do have ADHD, and you are feeling overwhelmed about the intake process, the best thing you can do is find someone without ADHD (a family member, a friend) who can help you through the process and diagnosis. It's difficult and time consuming, ask people you trust to help you fill in your gaps while you're figuring things out.

If you're interested in setting up your own CBT schedule and you think you have the ability to follow a consistent schedule, then buy a CBT book[0] and read through it and see if it's right for you. I am skeptical that self-help solutions will work long-term for the majority of people with ADHD, but at the very least you'll be able to get a little bit of an overview and figure out if CBT resonates. Heck, going off of the advice above, find a friend or a family member without ADHD who will go through the book with you and do the exercises alongside you. They won't be a licensed therapist, but they can help keep you on schedule and read off the page, and it's not like you're getting personalized one-on-one advice from this app.

[0]: I personally recommend https://www.amazon.com/Cognitive-Behavioral-Therapy-Adult-AD...

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